Temporary Pacemakers
Medtronic, Inc., Minneapolis, MN
June 2007
Model 5388 Dual Chamber Temporary Pacemaker
1. Pace/Sense LEDs
2. Lock/Unlock Key
3. Lock Indicators
4. Rate Dial
5. Atrial Output Dial
6. Ventricular Output Dial
7. Menu Parameter Dial
8. Parameter Selection Key
9. Menu Selection Key
10. Pause Key
11. Power On Key
12. Power Off Key
13. Emergency/Asynchronous
Pacing Key
14. Lower Screen
15. Ventricular Output Graphics
16. Atrial Output Graphics
17. Upper Screen
18. Rate Graphics
19. Setup Indicators
20. DDI Indicator
21. Low Battery Indicator
22. Setup Labels
Medtronic, Inc., Minneapolis, MN
June 2007
Off / On Keys
Values at Power-On
Dual Chamber Pace/Sense
• RATE 80 ppm
• UPPER RATE 110 ppm
OFF ON Push once
Push twice
Medtronic, Inc., Minneapolis, MN
June 2007
Emergency Key
Emergency Pacing Values
• RATE Current Rate
• A OUTPUT MAX
• V OUTPUT MAX
• PACING ASYNC
• NO SENSING!
Always available – Single key
press enters Emergency mode
Use caution when setting the
device to asynchronous modes.
Medtronic, Inc., Minneapolis, MN
June 2007
Pause Key – Check Patient’s
Intrinsic Rhythm
10 seconds max
Medtronic, Inc., Minneapolis, MN
June 2007
Indicators
Pace/Sense Indicators
(Flashing Lights)
Padlock
Pace/Sense Indicator
Setup Indicators (“is the device
(“how is the device setup?”) locked?”)
Medtronic, Inc., Minneapolis, MN
June 2007
Lock / Unlock
Locks Rate, V Output,
A Output dials
Lock/Unlock Key
Lock Indicator
To unlock push the
“Lock/Unlock” Key
Padlock Flashing Key
Icon Icon
Emergency key is
Medtronic, Inc., Minneapolis, MN always available
June 2007
Rate and Output Adjustments
Single or Dual Chamber Pacing With Only 3 Dials!
Max rate of
Rate Dial 200bpm for
pediatrics
Atrial Output Dial
For Single Chamber pacing, turn
OFF Atrial output
Ventricular Output Dial
Medtronic, Inc., Minneapolis, MN
June 2007
Lower Screen Menus
Menu 1: Pacing Menu 2: Rate-Based
Parameters Pacing Parameters
Menu 3: Rapid Menu M:
Atrial Pacing Dial-A-Mode
Medtronic, Inc., Minneapolis, MN
June 2007
Device Usage - Cable Connectors
• Connector pins on the
lead(s) must be fully
inserted in the patient
connector block
• Observe polarity
• Finger tighten only – no
tools!
Medtronic, Inc., Minneapolis, MN
June 2007
Cable to Device Connections
Cable clicks in place
Make sure device is OFF
Medtronic, Inc., Minneapolis, MN
June 2007
Emergency Connections
Temporary use only -
Leads do not lock in place
Medtronic, Inc., Minneapolis, MN
June 2007
Battery Operation
Replace the battery for each new patient
Low Battery Indicator
Check Status
Low Battery Indicator Check battery status at least
When indicator first twice per day – replace
appears you have battery when indicator is on
approximately 24 hours of
pacing remaining Replace battery at least once
per week when device is in
Medtronic, Inc., Minneapolis, MN
continuous use
June 2007
Battery Replacement
1 4
2 3
1 sure the drawer clicks shut
Make
2
15 seconds of pacing provided
while changing 9V battery
Medtronic, Inc., Minneapolis, MN
(note: battery polarity is reversible)
June 2007
Pacing Setup Table
Model 5388 Pacing Setup Table
Medtronic, Inc., Minneapolis, MN
June 2007
NBG Codes
1st Letter 2nd Letter 3rd Letter
Chamber(s) Paced Chamber(s) Sensed Response to Sensing
A = atrium A = atrium I = inhibit
V = ventricle (Demand mode)
V = ventricle
D = dual T = triggered
D = dual (both atrium
O = none D = dual
and ventricle)
O = none (Asynch)
Chamber paced
Chamber sensed
Action or response to a sensed
event
V V I
Medtronic, Inc., Minneapolis, MN
June 2007
Setting Sensitivity
The degree that the pacing system “sees” or senses signals,
controlled by the sensitivity setting which is graduated in
millivolts (mV)
5 (mV)
Sensitivity (mV)
2.5 (mV)
1.25 (mV)
Sensitivity settings should provide at least a 2:1 safety margin
Medtronic, Inc., Minneapolis, MN
June 2007
Sensing Threshold Procedure
1. Set rate at least 10 ppm below patient’s intrinsic rate.
2. Adjust output: Set OUTPUT to 0.1 mA (A OUTPUT for atrial threshold; V
OUTPUT for ventricular threshold).
3. Highlight SENSITIVITY (atrial or ventricular) (Menu 1).
4. Decrease SENSITIVITY: Slowly turn MENU PARAMETER dial
counterclockwise until pace indicator flashes continuously.
5. Increase SENSITIVITY: Slowly turn MENU PARAMETER dial clockwise
until sense indicator flashes and pace indicator
stops flashing. This value is the sensing threshold.
6. Set SENSITIVITY to half (or less) the threshold value.
This provides at least a 2:1 safety margin.
7. Restore RATE and OUTPUT to previous values.
Medtronic, Inc., Minneapolis, MN
June 2007
Atrial/Ventricular Sensing Thresholds
Sensing
Atrial Undersensing
Medtronic, Inc., Minneapolis, MN
June 2007
Capture
Depolarization of cardiac muscle
following an electrical stimulus
Medtronic, Inc., Minneapolis, MN
June 2007
Stimulation Threshold
The minimum output pulse needed
to consistently capture the heart
3 mA 2 mA 1 mA
Set output to 2-3 times stimulation threshold
Medtronic, Inc., Minneapolis, MN
June 2007
Stimulation Threshold Procedure
1. Set RATE at least 10 ppm above patient’s intrinsic rate.
2. Decrease OUTPUT: Slowly turn OUTPUT dial counterclockwise
until ECG shows loss of capture.
3. Increase OUTPUT: Slowly turn OUTPUT dial clockwise
until ECG shows consistent capture.
This value is the stimulation threshold.
4. Set OUTPUT to a value 2 to 3 times greater than the stimulation
threshold value.
This provides at least a 2:1 safety margin.
5. Restore RATE to previous value.
Medtronic, Inc., Minneapolis, MN
June 2007
Atrial/Ventricular Stimulation Thresholds
Capture
Loss of Ventricular Capture
Medtronic, Inc., Minneapolis, MN
June 2007
Model 5348 Single Chamber
Pacemaker
Medtronic, Inc., Minneapolis, MN
June 2007
Basic Device Operation
Turning device off Battery Replacement
Push
Buttons at
the same
time
Push both buttons at the
same time to turn OFF
Medtronic, Inc., Minneapolis, MN
June 2007
Locking Feature and Emergency
Locking Feature
Slide plastic cover over
dials to protect against
changes in settings
Emergency Pacing MAX
output
• Rate Check Rate
• Output Turn to MAX
• Sensitivity Turn to ASYNC
Use caution when setting the
sensitivity to asynchronous
Asynch.
Medtronic, Inc., Minneapolis, MN
June 2007
Troubleshooting Pacemaker
Performance
Medtronic, Inc., Minneapolis, MN
June 2007
Troubleshooting Process
1. Gather information
2. Identify the problem and possible cause
3. Identify the solution and carry out
corrective procedures
Medtronic, Inc., Minneapolis, MN
June 2007
Loss of Capture
Electrical stimuli delivered by
the pacemaker does not initiate
depolarization of the atria or
ventricle
Medtronic, Inc., Minneapolis, MN
June 2007
Loss of Capture
Possible Causes Corrective Measures
•Threshold rise •Increase output (mA)/check thresholds
•Fractured/dislodged lead •Replace/reposition lead
•Battery depletion •Replace battery
•QRS not visible •Adjust ECG
•Tissue is refractory •Assess mode selection
•Faulty cable connections •Check connections
•Switch polarity (epicardial system)
Medtronic, Inc., Minneapolis, MN
June 2007
No Output
Pacemaker fails to emit stimuli
at the programmed intervals
Medtronic, Inc., Minneapolis, MN
June 2007
No Output
Possible Causes Corrective Measures
•Battery depletion •Replace battery
•Pacemaker OFF •Verify pacemaker settings
•Faulty cable connections •Check cable connections
•Fractured/dislodged lead •Replace/reposition lead
•Oversensing •Verify/adjust sensitivity
Medtronic, Inc., Minneapolis, MN
June 2007
Undersensing
Failure of the pacemaker to
sense
intrinsic R-waves or intrinsic
P-waves
Medtronic, Inc., Minneapolis, MN
June 2007
Undersensing
Possible Causes Corrective Measures
•Decreased QRS voltage •Increase sensitivity
•Fractured/dislodged lead •Replace/reposition Lead
•Battery depletion •Replace Battery
•Inappropriate sensitivity setting •Sensing test/increase sensitivity
•Fusion beat
Medtronic, Inc., Minneapolis, MN
June 2007
Fusion/Pseudofusion Beats
Intrinsic Beat Paced Beat
Intrinsic Beat Paced Beat
Fusion Beat Pseudofusion Beat
Fusion Beat Pseudofusion Beat
Medtronic, Inc., Minneapolis, MN
June 2007
Oversensing
Inhibition of the pacemaker by
events
pacemaker should ignore, e.g. EMI,
T-waves and myopotentials
Medtronic, Inc., Minneapolis, MN
June 2007
Oversensing
Possible Causes Corrective Measures
•Fractured/dislodged lead •Replace/reposition lead
•Environmental interference •Eliminate interference
•T-wave oversensing •Sensing test/decrease sensitivity
•Faulty cable connections •Check connections
Medtronic, Inc., Minneapolis, MN
June 2007
References
• Dubin D. Rapid Interpretation of ECGS. 6th ed.
Tampa: Cover, Inc; 2000.
• Ellenbogen KA, Wood MA. Cardiac Pacing & ICDS.
3rd ed. Malden: Blackwell Science, Inc; 2002.
• Fogoros RN. Electrophysiologic Testing. 3rd ed.
Malden: Blackwell Science, Inc; 1999.
• Hayes DL, Lloyd MA, Friedman PA. Cardiac Pacing
and Defibrillation: A Clinical Approach. Armonk:
Futura; 2000.
• Moses HW, Moulton KP, Miller BD, et al. A Practical
Guide to Cardiac Pacing. 4th ed. Boston: Little,
Brown; 1995.
Medtronic, Inc., Minneapolis, MN
June 2007
